Provider Demographics
NPI:1861482770
Name:KINANE, THOMAS BERNARD (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:BERNARD
Last Name:KINANE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-726-8707
Mailing Address - Fax:617-724-2803
Practice Address - Street 1:275 CAMBRIDGE ST, STE 530
Practice Address - Street 2:MASS GENERAL HOSPITAL FOR CHILDREN
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114
Practice Address - Country:US
Practice Address - Phone:617-726-8707
Practice Address - Fax:617-724-2803
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA73312208000000X, 2080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3074048Medicaid
MA724771OtherTUFTS HEALTH PLAN
MAJ12563OtherBCBS MA
MA724771OtherTUFTS HEALTH PLAN
MAJ12563Medicare ID - Type Unspecified